Online therapy for obsessive-compulsive disorder beats medication

Given up on therapists? Jump online for a better chance of dealing with issues such as hoarding or OCD.

Online therapy is well on the way to complementing more traditional forms of psychological treatment. Trials of a new e-treatment for obsessive-compulsive disorder (OCD) reveal that it is at least three times more effective than medication.

A group-based treatment for hoarding disorder has also proved effective and is now being converted into an online resource for treating the affliction.

Photo: Louise Kennerley

Acclaimed OCD expert Professor Mike Kyrios, the director of the Australian National University Research School of Psychology, unveiled the study findings in a public lecture on Monday.

“Hoarding and OCD are treatable, even though some people seem to think they are not,” Professor Kyrios said. “We have been developing online treatments that are very, very effective.”

They certainly work better than what scientists know about medication treatment, Professor Kyrios explained. “We compared OCD Stop! against an online relaxation treatment, helping people deal with their anxiety in difficult situations. It, too, was effective although the cognitive-behaviour therapy program was significantly better.”

Those most likely to benefit from online therapy include people who feel too much shame about their OCD because of the nature of the unwanted thoughts they are having. “In addition, people who can’t access an experienced therapist, such as those living in rural and remote communities could visit their doctor, while at the same time going through this more specific OCD program,”

– Professor Michael Kyrios, ANU

“Finally, patients who have attended the standard rebated 10 sessions a year and can’t afford to keep going privately, could benefit by continuing with this program.”

Professor Kyrios said the management of hoarding disorder in Australia had improved significantly since the condition was added in 2013 to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

“The nice thing about including hoarding in the manual is that mental health has now come to the party in terms of being able to treat hoarding,” he said. “Until then, mental health services would not help.”

In the past, hoarding was considered a type of OCD but psychologists working in this area know that hoarders are different.

Traditional psychiatric wisdom says that while many anxiety disorders respond to psychotherapy, OCD sufferers do not always respond. This has been taken, in some circles, to imply that it is a biologically based condition requiring medication management. Hoarding and OCD are treatable, even though some people seem to think they are not.

Other scientists are interested in how the research stacks up; if it’s positive, this may challenge their present understanding of obsessive-compulsive disorder.

Online therapy: helping treat depression in rural areas

People in rural communities struggling with depression may not have easy access to the full range of mental health services, but help could be as close as the click of a mouse.

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Seeking help for depression is never easy, but for people in rural and regional communities the challenges can be overwhelming.

While the rates of depression are similar in urban and rural areas, those living outside metropolitan centres often struggle to access proper treatment.

First, there’s a serious shortage of mental health services, for example about 90 per cent of Australian psychiatrists based in major cities.

Then there’s the privacy question: even if you are lucky enough to get an appointment with a health professional, you’re likely to bump into them at the school sports day or in the main street on Saturday morning.

On top of that, the famed self-reliance of people living in the bush can make them reluctant to ask for help, in the belief they should be able to fix their own problems.

All this means that rural people are less likely to get help for depression early, meaning the condition can get worse in the absence of treatment.

Online answers

Internet-based therapy is shaping up to be one possible depression treatment for people who live in remote locations. And new research suggests online therapy might be as effective as face-to-face counselling.

Researchers from the University of New South Wales and St Vincents Hospital had the needs of rural and socially isolated people in mind when they developed their ‘Sadness’ program.

The online program uses the techniques of cognitive behavioural therapy to tackle symptoms of depression and improve coping strategies.

Participants spent roughly four hours a week doing the program, which included six online lessons and homework, a moderated Internet discussion group, and weekly emails from a clinical psychologist.

The small study monitored 45 people with mild to moderate depression, some of the group took part in the program while others were put on a ‘waitlist’.

After eight weeks, more than one third of the participants who had completed the program no longer met the criteria used to diagnose depression. This is a result similar to those experienced in more conventional, face-to-face treatments.

Identifying certain thoughts

The plight of people in the bush was also one impetus behind Australian National University research to develop MoodGYM – an online therapy program for depression and anxiety.

The resulting MoodGYM program uses a series of online learning modules and “homework” to help users identify and overcome certain types of dysfunctional or “warpy” thoughts.

You can work through these modules independently or in conjunction with treatment by a doctor or counsellor. Users have to register before they can access the program and the information they enter may be used for research purposes, but remains anonymous.

Since it was first rolled out in 2001, MoodGYM has been accessed by hundreds of thousands of people from more than 200 countries, says its lead developer Professor Helen Christensen. More than 20 per cent of those users come from rural or remote areas.

Research has shown completing the MoodGYM modules can significantly reduce symptoms in people with mild to moderate depression.

In one study, researchers rolled MoodGYM out in 29 Year 9 classrooms around Australia – more than a third of them in rural areas. The teenagers who used the program had a reduction in anxiety symptoms and the boys also experienced a reduction in depression.

Only 14 boys needed to use the program to prevent one case of depression, the study found.

There is no one-size-fits-all solution for people with depression, whether they come from rural areas or the city, Christensen says. While some people will respond better to the anonymous environment of online counselling, others really need the face-to-face contact with a counsellor.

Christensen believes the future may lie in better integration of online and conventional services, allowing individual patients to receive whatever combination delivers the best results for them.

But online programs do tend to suit people who take a “self-help” approach to their health, Christensen says, which may be one reason they seem to go down well in the bush.

Signs of depression

Signs of depression can include a range of physical symptoms (loss of energy or changes in appetite or sleep patterns), negative thoughts, inability to concentrate or reluctance to engage in normal activities. (For more information on depression see our depression fact file.)

If you think you may have depression, it is best to see a doctor or mental health professional to ensure you receive the most appropriate treatment, which may include online treatment. Although online therapy helps many people, it is not suitable for those with severe depression or suicidal thoughts who need to seek immediate professional help.

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